Integrating Primary and Behavioral Health Care: Social Work Research Opportunities and Challenges

Background: Passage of the Patient Protection and Affordable Care Act (ACA) is rapidly changing the face of how health and mental health care is delivered in the U.S and these changes have broad implications for social work practice and research. In addition to increasing access to health care for millions of Americans, the ACA is also promoting the integration of health care. Integrated health is a move away from fragmentation and separation of physical and mental health care to a coordinated, prevention-focused model of care.  It requires a holistic approach in which the whole person is an active member of an interprofessional team of providers. In 2014, the Health Resources Service Administration (HRSA) awarded over $27 million to 62 social work programs to prepare MSW students to work in integrated health care settings. Additionally, $54 million was awarded to community health centers to hire mental health professionals. With the projected Department of Labor increase of 39,200 health care social workers and 26,000 mental health/substance abuse social workers by 2022. This expansion of the profession’s work force and the transformation of the health care environment, present a host of opportunities and challenges for research, practice and education.   

Overview:  With our bio-psychosocial perspective, experience in navigating overlapping systems and our emphasis on inclusion and social justice, there is no doubt that the social work profession is well-suited to facilitate these changes. However, it is also clear that we must be able to carefully demonstrate how social work can advance the aims of the ACA and how specific interventions can contribute to: 1) cost reductions by preventing expensive forms of care such as hospitalizations and emergency room visits and 2) promoting better health outcomes. As the shift to integrated care is still in its infancy, there is little existing research to help guide the way. Therefore, it is incumbent on those in leadership positions to work collaboratively to define desired outcome and develop research designs, methodologies, and measures appropriate to the model of integration as well as the setting and population. Similarly, those responsible for training students to work in this rapidly changing environment must devise new curricula and the means to evaluate them.

Methods:  This Roundtable will bring together HRSA grantees from six schools of social work to lead a discussion that will address the opportunities and challenges described above:  More specifically participants will seek to answer the following key questions: 1) As integrated care is implemented around the country how can social work show improved outcomes; what should these organizational and individual outcomes be and how might they be systematically measured? and 2.) How can the integrated care core competencies developed by HRSA and CSWE be operationalized and measured?  

Conclusion: Social work has the opportunity and skills necessary to be a part of the solution to healthcare delivery. To be successful, it is imperative that we work collaboratively, pooling resources and expertise.  It is intended that this roundtable will spawn ongoing partnerships and collaborations to help meet these challenges.